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The subjects of this study were 208 patients who underwent endoscopic hemostasis at the Department of Gastroenterology and Hepatology, Iwate University between January 2004 and December 2008. There were 153 men and 55 women with a mean age of 65.3 years. Among them, 181 patients underwent endoscopic hemostasis in the stomach or duodenum and were divided into the peptic ulcer and artificial ulcer groups. The following were retrospectively analyzed: success rates of endoscopic hemostasis, rates of rebleeding, and devices used during treatment. The overall success rate of endoscopic hemostasis was 97.2%. Hemostasis was achieved in 98.2% of the cases with peptic ulcer bleeding and in 88.9% of the cases with artificial ulcer bleeding. Monotherapy (one hemostatic device) was used in 141 cases (77.9%), combination therapy (multiple hemostatic devices) was used in 39 cases (21.5%), and primary hemostasis was used in one case (0.6%) because of blood flow reduction during the observation period. A heat probe was used in 145 cases (80.1%), making it the most frequently used device. Endoscopic hemostasis is very effective for nonvariceal upper gastrointestinal bleeding.

Upper airway obstruction can be life-threatening in neonates and infants with CHARGE syndrome, many of whom undergo intratracheal intubation early in life. Although some of these patients are successfully extubated, others require tracheotomy. Deciding whether to complete tracheotomy is challenging since there are no clear criteria upon which to base this decision. We assessed 10 infants with CHARGE syndrome, 5 of whom required tracheotomy. Fiberoptic laryngoscopy showed that all of these patients shared certain features: anteroposterior flattening of the larynx; short vocal cords; anteriorly positioned, tall and hypertrophic arytenoids obscuring the glottis; uncoordinated movement of the vocal cords, epiglottis and arytenoids; salivary pooling. In addition, we observed only in those requiring tracheotomy an obstructive supraglottis that prevented visualization of the vocal cords throughout respiration. Salivary retention was much more severe in this group. These findings might be helpful for predicting the need for an early tracheotomy in situations where the vocal cords are not visible throughout the entire respiratory cycle. Given the high prevalence of malformed larynx and abnormal cranial nerve function, which are not alleviated by supraglottoplasty, we suggest that a thorough investigation of upper airway obstructive entities other than laryngomalacia be performed before embarking on supraglottoplasty in patients with CHARGE syndrome.

Respiratory distress is one of the major complications in young infants with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries (PA-VSD-MAPCA); however, its aetiology remains obscure. We have previously reported an association of bronchomalacia with PA-VSD-MAPCA in patients with a hemizygous deletion of chromosome 22q11.2 (del.22q11). To clarify the clinical relevance of bronchomalacia in patients with PA-VSD-MAPCA and del.22q11, we reviewed the clinical and laboratory records of four patients with PA-VSD-MAPCA who had del.22q11 and bronchomalacia. External bronchial compression by anomalous patterning of the aorta and MAPCA was documented in three of the four patients, using combinatorial examination of angiocardiography, bronchography, fibreoptic bronchoscopy and magnetic resonance imaging. One of the four patients died suddenly of severe respiratory distress at 4 years of age, while the remaining three were inoperable for complete surgical repair. Our study indicates that bronchomalacia as a result of external vascular compression may be an aetiology of early-onset respiratory distress in some patients with PA-VSD-MAPCA and del.22q11, and can significantly affect the clinical outcome.